Brad Fluegel: How Is Healthcare Changing?Brad Fluegel


By Brad Fluegel


How is healthcare changing and who is benefitting? What plans should we be making and what do we need to be thinking about?

I approach those questions from the perspective that first of all, human beings don’t live in the healthcare universe. They live in the real world. Even people who are dealing with diabetes or other chronic conditions are not exclusively focused on healthcare 24 hours a day. They are driving their cars to the grocery store or taking their kids to school.

In fact, most people are going to think only periodically about even chronic conditions. They have their lives to live.  We have to meet them where they are and not force them to conform to the requirements of the health care system.

We do see that some wealthier people have the ability to devote more of their time, attention, and resources to managing their health and use expensive technologies. Unless you’re a rich venture capitalist in Silicon Valley and can afford to be obsessed with all kinds of newfangled technologies that help you track fitness and health, chances are you won’t. Most people don’t have the time or money or energy.

I have noticed that the various stakeholders in the healthcare universe honestly care deeply about helping people. They do not only care about making a lot of money, even though many people in our society believe they do. The costs of insurance, prescription drugs, hospitals and physicians can be quite high, which reinforces that perception. Yet in my experience, most everyone in the world of health care is honestly trying to do good. They just don’t know how to integrate into patients lives and connect everything all together – their lives as both people and patients.

So, when I think about what the future holds for healthcare, I think we will see an integration of all the new technologies and data from various sources into people’s lives on a moment-by-moment basis to support the goal of making lives and health better.

In practical terms, how will that be reached?

I believe, that to engage consumers, everyone in healthcare needs to put a support system around consumers that interacts with them as part of their daily lives. We need to meet people where they are using tools, technologies and the places they are familiar with and already using.

That’s a great place for digital health companies and retail organizations to play a role. One thing they can do is to develop technologies that can remotely monitor patients in their homes – in effect, to monitor how people are doing and alerting them and their care teams if a problem is detected.

Apple and many others are trying to do that with wearables,  apps  and other technologies. There are a whole slew of other companies, some of which are profiled in this book, that are trying to use technology-supported by services to help people live healthier lives and better manage their chronic conditions.

Retailers are also diving deep into this. We have to remember that although customers are going on line more and more, they still go to stores a lot. That is not going away. So companies like Walgreens and CVS are creating what CVS calls health hubs and what Walgreens calls health destinations within some of their stores. In them, people can now meet with a clinician for urgent issues, as well as for more chronic concerns, get lab tests, discuss their diets and get other services as well.

But at the end of the day, retailers and technology can’t do it all by themselves.

Traditional players have to lead on this as well. Doctors and health systems will continue to have an important role to play, because they’re still most trusted by the patients who are under their care. And so some of the tools, whether they are services from retailers or technology companies, will need to be integrated with the services that physicians are providing to their patients, so that these newer telehealth and digital services don’t sit on an island that is disconnected from the regular care pathways that many patients might be on. Patients often look to and trust their primary care providers and specialist physicians, and that will not change.

We have seen that happen during Covid-19. To be sure the pandemic brought about a lot of change in health care, but one of the things that I found most interesting was that although there was a big spike in Telehealth visits to Telehealth providers, there was also a massive increase in the Telehealth offerings from traditional providers – people still wanted to interact with physicians they knew and trusted. Telehealth did not cause people to turn away from that. They still wanted to have a relationship with someone, often their doctor, or with someone in their doctor’s practice. They didn’t want to get advice or care from some random doctor, or some technology portal  other than perhaps for some kind of kind of acute issue that emerged.  The acceptance of telehealth from traditional providers was the real game-changer and will open the door to more convenient care for patients and improve outcomes.  They will need technology to help them connect it all.

Another important change during the pandemic was that there came to be reimbursement parity between online and in-person visits. Whether you saw your physician during a telemedicine session or in his or her office, the provider received the same amount of money. That drove a massive cultural shift within providers that I think is going to stick.  I believe that in the long term, that change will be better for patients. Telemedicine is not going to replace in-person visits. But I think it represents a step change in usage for the traditional systems.

The fact that more people were working remotely during the pandemic brought about change in employer-provided programs too. There were suddenly more employees working from home, sometimes part-time, and often with children at home too. This lead to stress that was exacerbated by the isolation and loneliness that accompanied the lockdowns. Mental health issues and access to care became issues that employers and health plans had to address. Here again technology and connection have an important role to play.

Yet it is surprising that during the pandemic, the overall number of mental health visits came down – virtual visits were way up but more than offset by the decline in physical visits.  I think that’s going to create a big crisis, particularly for kids. The prevalence of eating disorders and anxiety and depression among young people who haven’t been able to go to school or be socialized is a concern. There could be a huge wave of adverse events just waiting to happen down the road. That’s something the industry has to anticipate and find ways to fix.

I’m also concerned that preventive screenings and care delayed during the pandemic may lead to a spike in illnesses and costs over the longer term. Technologies like those described in this book will be critical to addressing all of theses issues.

And then lastly, I’d say with regard to health plans, they’re all trying to get closer to patients and closer to their members. And I think they’ll continue to do that. Over time, they will stitch together a system across not just traditional health care providers, but technologies, non-traditional business partners and others that are interacting with their members. They have an important navigational role to play in the in the future health care system. That’s not possible without the connectedness advocated in this book

So, what does all this innovation mean?

Not much if you don’t connect to it, which is what this book explores. It has been said that our smartphones are democratizing healthcare in much the same way that Gutenberg’s printing press did the written word back in the 14th century. While regulation has slowly caught up to how to better integrate new technologies into our reimbursement workflows, It Takes a Village explains how you can tap in to take advantage and take control of your health. There is a cornucopia of resources available to you today that you never had before. You can’t benefit unless you plug in and get connected. All you need is your smartphone—To your health!


About Brad Fluegel

Brad Fluegel currently advises health care organizations, entrepreneurs, private equity firms and other participants in healthcare. He recently retired from being the Senior Vice President  and Chief Strategy Officer at Walgreens based in Deerfield, Ill.

Brad now serves on the Board of Directors at  Metropolitan Jewish Health System in New York City, Performant Financial Corporation,  Premera Blue Cross and Alight Solutions.  He served on the Board of Fitbit until its sale to Google in early 2021

Brad earned a master’s degree in public policy from Harvard University’s Kennedy School of Government and a Bachelor of Arts in business administration from the University of Washington.  He also serves as a lecturer at the University of Pennsylvania’s Wharton School of Business. Follow Brad Fluegel on Linkedin.

The Digital Health Guy’s next book, It Takes a Village coming soon!